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2476500-261620Guidance on Assessing Emergency Department Data for Non-Traumatic Dental ConditionsJuly 2017 (updated September 2017)Due to the technical nature of this topic, this information will be most helpful to dental directors, data analysts, epidemiologists and statisticians.Does your state want to assess the use of emergency departments for non-traumatic dental conditions?If yes, then you probably have questions about data sources, indicators of interest, diagnostic codes, analysis methods, target populations and potential predictive factors. The purpose of this document is to provide a standardized framework for how state oral health programs (SOHPs) should evaluate and document the use of emergency departments (EDs) for non-traumatic dental conditions (NTDCs). By following this guidance, SOHPs will be able to compare their ED data to information from other states and have the ability to assess trends in ED use over time. While the focus of this guidance is the generation of state specific estimates using statewide ED discharge databases, the recommended codes and analysis techniques can be used for databases that are specific to a local community (e.g., hospital service area) or target population (e.g., Medicaid). This guidance is an abbreviated version of the ASTDD report, Recommended Guidelines for Surveillance of Non-Traumatic Dental Care in Emergency Departments. If you need more detailed information, including previously published research, please refer to Recommended Guidelines for Surveillance of Non-Traumatic Dental Care in Emergency Departments and its companion report, Methods of Assessing Non-Traumatic Dental Care in Emergency Departments.Where do I get state specific ED discharge data?In general, there are two sources for state specific ED data: (1) the State Emergency Department Databases (SEDD) and (2) other state ED databases. State Emergency Department DatabasesThe SEDD are a set of databases and software tools developed for the Agency for Healthcare Research and Quality’s?Healthcare Cost and Utilization Project (HCUP). The SEDD capture emergency visits at hospital-affiliated EDs that do not result in hospitalization. The SEDD files include all patients, regardless of payer, providing a unique view of ED care in a state over time. As of July 2017, 35 states participate in the SEDD. The SEDD contain a large number of clinical and non-clinical variables included in a hospital discharge abstract, such as:?All-listed diagnoses and proceduresPatient demographic characteristics (e.g., sex, age and, for some states, race)Expected payment sourceTotal charges.Variables included in the SEDD are not always available for all states; refer to Availability of Data Elements by Year for additional information on which variables are available for your state. SEDD releases can be purchased through the?HCUP Central Distributor. Costs vary by state; for 2014 they ranged from $50 to $3,200. Data for earlier years are often available at a lower cost.?Other State ED DatabasesIf your state does not participate in the SEDD, there may be another source for statewide ED data. ASTDD recommends that SOHPs discuss the issue of use of EDs for NTDCs with your state health officer and determine if SEDD or another state ED discharge database is available for analysis. The recommendations and methods presented in this document should be generally applicable to both SEDD and non-SEDD state ED discharge databases. What diagnostic codes should we use?To assure comparability between states, ASTDD recommends that all states use the ICD codes listed in Appendix 1. Based on the ICD-9 and ICD-10 diagnostic codes, ASTDD has created two broad categories for ED visit due to an oral condition: (1) non-traumatic dental condition (NTDC) and (2) caries, periodontal or associated preventive procedures (CPP). NTDC includes caries, periodontal disease, erosion, occlusal anomalies, cysts, impacted teeth, teething, and all other non-traumatic conditions associated with the oral cavity. Diagnoses that are deemed due to trauma are excluded from this definition. CPP includes only those conditions directly associated with dental caries, periodontal disease, or preventive procedures associated with these diseases that are routinely provided in a dental clinic setting. CPP would include diagnoses related to dental caries, gingival and periodontal conditions, loss of teeth (not due to trauma), endodontic conditions, and caries and periodontal related preventive procedures. The codes for NTDC are a subset of all oral and facial related codes, and the codes for CPP are a subset of the NTDC codes. Refer to Appendix 1 for a listing of the specific ICD-9 and ICD-10 codes for NTDC and CPP. If you want all oral and facial related codes and codes for NTDC and CPP as an Excel spreadsheet for easier use in data analysis, click here.IMPORTANT NOTE: On October 1, 2015, the United States transitioned from using ICD-9 to ICD-10 code sets. The SEDD databases are annual, calendar-year files. The introduction of ICD-10 on October 1 means that the 2015 databases include a combination of codes: nine months of the data with ICD-9 codes (01-01-2015 to 09-30- 2015) and three months of data with ICD-10 codes (10-01-2015 to 12-31-2015). Therefore, for 2015, code sets determining ED oral condition visit outcomes will include both ICD-9 and ICD-10 codes. NOTE: The comparability of estimates across the ICD-9 to ICD-10 transition is uncertain and may potentially over- or under-estimate various indicators. ASTDD recommends keeping your analysis distinct to either ICD-9 or ICD-10, and using caution when comparing across the transition.Should I use the reason for visit codes or the diagnostic codes?The SEDD databases contain codes for reason for visit, often referred to as presenting complaint(s), plus codes for ED physician’s diagnoses, which may not necessarily match the patient’s reason(s) for visit. For example, a patient may have a presenting complaint of “chest pain” while the physician’s diagnosis is “hiatal hernia.” Since reason for visit and diagnosis provide valuable yet potentially different (patient vs. physician) information on ED use for NTDCs, ASTDD has developed indicators that assess both types of codes (refer to Table 1). Using both types of indicators can be especially important for ED discharge data having an oral related reason for visit without a corresponding oral related diagnostic code (or vice versa). NOTE: Some ED discharge databases may not contain code(s) for reason for visit.Should I evaluate first listed diagnosis or any listed diagnosis?An ED record may include multiple diagnostic codes. The first listed diagnosis is often considered to be the “primary” or most important diagnosis by the physician. For example, a patient may have a first listed diagnosis of a non-oral medical condition or a trauma related oral condition such as “dislocation of the jaw” and a second listed diagnosis of “unspecified gingival and periodontal disease.” If only the first listed diagnosis is included in the analysis, this patient would not be classified as having an ED visit for a NTDC. If all listed diagnoses are considered, this patient would be classified as having an ED visit for a NTDC. By using all diagnoses, untreated dental conditions presenting at an ED can be tracked, even if the condition was not the primary diagnosis for the ED visit. ASTDD has developed indicators that assess both first listed diagnosis and any listed diagnosis (refer to Table 1).What oral health indicators should we evaluate?Analyzing an ED database will allow you to evaluate a multitude of oral health indicators. Because the total number of indicators can be overwhelming, ASTDD has developed a core or foundational set of five indicators to include in a state ED-NTDC surveillance system. We encourage states to expand their ED-NTDC surveillance to include a wider variety of indicators and predictors based on the needs and resources of the individual state. For information on other potential indicators and predictors, refer to Recommended Guidelines for Surveillance of Non-Traumatic Dental Care in Emergency Department. If you are interested in expanding your ED-NTDC surveillance system beyond the core set of five indicators and recommended predictors, Appendix 2 provides information on optional factors/analyses that you may want to consider.Recommended indicators (refer to Table 1 for additional detail):ED visit for NTDC based on first listed diagnosisED visit for NTDC based on any listed diagnosisED visit for NTDC based on first listed reason for visitED visit for NTDC based on any listed reason for visitED visit for NTDC based on any listed diagnosis and/or any listed reason for visit (most inclusive).Recommended reporting and stratification variables (refer to Table 2 for additional detail):For each of the five recommended indicators, ASTDD suggests that states report, at a minimum:Count – number of ED visits associated with specific outcome in a given yearRate per 100,000 population using Census Bureau population estimates Count divided by population multiplied by?100,000It may not be possible to calculate rate per 100,000 population when data are stratified by primary payer or race/ethnicity Rate per 10,000 ED visitsCount divided by total ED visits multiplied by?10,000Total charges associated with each indicator (use SEDD variable – TOTCHG)States, at a minimum, should report overall estimates plus estimates stratified by:Age (< 20, 20-44, 45-64, 65+)These age groups were selected because population estimates are readily available from the U.S. Census. As part of an expanded ED-NTDC surveillance system, states may opt to generate estimates for smaller age groupings. Primary payer (Medicare, Medicaid, private insurance, uninsured, other)NOTE: Information on the number of individuals with each payer type is not readily available. Because of this, it may not be possible to generate rate per 100,000 population.Race/ethnicity if available (white, black, Hispanic, Asian/Pacific Islander, Native American, other)NOTE: The SEDD coding for race does not align with the U.S. Census coding for race. Because of this, it is not possible to generate rate per 100,000 population.Table 1: Recommended ED-NTDC indicators and the appropriate SEDD data elementsIndicatorSEDD Data Element, ICD-9 SEDD Data Element, ICD-10Comments/NotesNTDC 1st diagnosisDX1 I10_DX1Include 1st listed diagnosis onlyNTDC any diagnosisDXnI10_DXnInclude all listed diagnosesNTDC 1st reason visitDX_Visit_Reason1 I10_Visit_Reason1Include 1st listed reason onlyNTDC any reason visitDX_Visit_Reasonn I10_Visit_ReasonnInclude all listed reasonsNTDC any diagnosis/visitDXn & DX_Visit_Reasonn I10_DXn & I10_Visit_ReasonnInclude all listed diagnoses & reasonsTable 2: Recommended ED-NTDC analysis and stratification factors with SEDD data element namesDescriptionSEDD Data ElementComments/NotesTotal ChargesTOTCHGGenerally, TOTCHG does not include professional fees and non-covered charges. Refer to SEDD’s state specific notes for additional detail.AgeAGE or AGEGROUPMost states report age while some may only report by age group.Primary payerPAY1To ensure uniformity across states, PAY1 combines detailed categories into more general groups. Refer to SEDD’s state specific notes for additional detail.Race/ethnicity(if available)RACEHCUP coding includes race/ethnicity in one data element (RACE). If the state supplied race and ethnicity in separate data elements, ethnicity takes precedence over race in setting the HCUP value for race. Race is not available for all states. Refer to SEDD’s state specific notes .What statistical software package and program code should I use?Any statistical software package can be used. If you are using a SEDD database, the HCUP Central Distributor provides load programs for SAS, SPSS and Stata. Refer to Appendix 3 for sample SAS code. Limitations and general issues to be aware of:Some individuals may seek care for NTDCs at urgent care clinics rather than hospital-based EDs. ED discharge databases such as SEDD do not include information from urgent care clinics.SEDD ED discharge databases include information on patients that were discharged from the ED, but do not include information on patients that presented at the ED and were subsequently admitted to the hospital. Information about patients initially seen in the ED and then admitted to the hospital is included in the State Inpatient Databases (SID). SID can be used by states interested in assessing the increment of oral condition ED visits resulting in hospital admission.Some patients may live in one state but seek ED care in a bordering state; the resident state ED database will not capture information on patients obtaining cross-state care. If a state wants to determine the extent of cross-state care, the ED discharge database for the neighboring state can be evaluated using the SEDD variable for patient state (PSTATE). Many ED datasets use unique identifiers associated with an ED visit, not a specific person. Because of this, repeat visits by a person cannot be identified and the extent of repeat visits to EDs for the same oral problem cannot be quantified. Check individual states to determine if linking variables (VisitLink, DaysToEvent –see Appendix 2) are available to assess repeat visits.Drug-seeking behavior may result in oral pain given as the reason for visit, skewing the picture of true oral care in EDs.Refer to Recommended Guidelines for Surveillance of Non-Traumatic Dental Care in Emergency Departments for a more complete description of limitations and concerns.Where can I get additional help?ASTDD may be able to help you with your analysis process. Please contact us if you have any questions.Association of State & Territorial Dental DirectorsMichael Manz, Surveillance Consultant, mmanz@umich.edu Kathy Phipps, Data and Surveillance Coordinator, kathyphipps1234@ AcknowledgementsSupported by a generous grant from the DentaQuest Foundation. Contents are solely the responsibility of the authors and do not necessarily represent the official views of the DentaQuest Foundation. ASTDD would like to thank Michael Manz for researching and preparing ASTDD’s non-traumatic dental care in emergency department reports. In addition, ASTDD would like to thank Emanuel Alcala, Krishna Aravamudhan, Marlene Bengiamin, John Capitman, Donna Carden, Amber Costantino, Mary Foley, Donald Hayes, Renee Joskow, Rich Manski, Lynn Mouden, Junhie Oh, Kathy Phipps, Eli Schwarz, Scott L. Tomar, and David A. Williams for their assistance in the development and review of this guidance and Beverly Isman and Chris Wood for their editing skills. References and additional resourcesRecommended Guidelines for Surveillance of Non-Traumatic Dental Care in Emergency Departments Methods of Assessing Non-Traumatic Dental Care in Emergency DepartmentsOverview of the State Emergency Department DatabasesAppendix 1The Recommended ICD-9 and ICD-10 Codes for Defining NTDC and CPPICD- 9 DescriptionICD-9 CodeICD-10 CodeICD-10 Description (if different)NTDCCPPAnodontia5200K000NTDCSupernumerary teeth5201K001NTDCAbnormalities of size and form of teeth5202K002NTDCMottled teeth5203K003NTDCDisturbances of tooth formation5204K004NTDCHereditary disturbances in tooth structure, not elsewhere classified5205K005NTDCDisturbances in tooth eruption5206K006Disturbances in tooth eruptionNTDCDisturbances in tooth eruption5206K010Embedded teethNTDCDisturbances in tooth eruption5206K011Impacted teethNTDCTeething syndrome5207K007Teething syndromeNTDCOther specified disorders of tooth development and eruption5208K008Other specified disorders of tooth developmentNTDCUnspecified disorder of tooth development and eruption5209K009 Disorder of tooth development, unspecifiedNTDCDental caries, unspecified52100K029Dental caries, unspecifiedNTDCCPPDental caries limited to enamel52101K0261Dental caries on smooth surface limited to enamelNTDCCPPDental caries extending into dentine52102K0262Dental caries on smooth surface penetrating into dentineNTDCCPPDental caries extending into pulp52103K0263Dental caries on smooth surface penetrating into pulpNTDCCPPArrested dental caries52104K023Arrested dental cariesNTDCCPPOdontoclasia52105K0389Other specified diseases of hard tissues of teethNTDCCPPDental caries pit and fissure52106K0251Dental caries pit and fissure surface limited to enamelNTDCCPPDental caries of smooth surface52107K0261Dental caries on smooth surface limited to enamelNTDCCPPDental caries of smooth surface52107K0262Dental caries on smooth surface penetrating into dentineNTDCCPPDental caries of smooth surface52107K0263Dental caries on smooth surface penetrating into pulpNTDCCPPDental caries of root surface52108K027Dental root cariesNTDCCPPOther dental caries52109K029Dental caries, unspecifiedNTDCCPPExcessive dental attrition, unspecified52110K030Excessive attrition of teethNTDCExcessive attrition, limited to enamel52111K030Excessive attrition of teethNTDCExcessive attrition, extending into dentine52112K030Excessive attrition of teethNTDCExcessive attrition, extending into pulp52113K030Excessive attrition of teethNTDCExcessive attrition, localized52114K030Excessive attrition of teethNTDCExcessive attrition, generalized52115K030Excessive attrition of teethNTDCAbrasion of teeth, unspecified52120K031Abrasion of teethNTDCAbrasion, limited to enamel52121K031Abrasion of teethNTDCAbrasion, extending into dentine52122K031Abrasion of teethNTDCAbrasion, extending into pulp52123K031Abrasion of teethNTDCAbrasion, localized52124K031Abrasion of teethNTDCAbrasion, generalized52125K031Abrasion of teethNTDCErosion, unspecified52130K032Erosion of teethNTDCErosion, limited to enamel52131K032Erosion of teethNTDCErosion, extending into dentine52132K032Erosion of teethNTDCErosion, extending into pulp52133K032Erosion of teethNTDCErosion, localized52134K032Erosion of teethNTDCErosion, generalized52135K032Erosion of teethNTDCPathological resorption, unspecified52140K033Pathological resorption of teethNTDCPathological resorption, internal52141K033Pathological resorption of teethNTDCPathological resorption, external52142K033Pathological resorption of teethNTDCOther pathological resorption52149K033Pathological resorption of teethNTDCHypercementosis5215K034NTDCAnkylosis of teeth5216K035NTDCIntrinsic posteruptive color changes of teeth5217K037Intrinsic posteruptive color changes of hard tissues of teethNTDCCracked tooth52181K0381NTDCCPPOther specific diseases of hard tissues of teeth52189K0389NTDCCPPUnspecified disease of hard tissues of teeth5219K039Disease of hard tissues of teeth, unspecifiedNTDCCPPPulpitis5220K040NTDCCPPNecrosis of the pulp5221K041NTDCCPPPulp degeneration5222K042NTDCCPPAbnormal hard tissue formation in pulp5223K043NTDCAcute apical periodontitis of pulpal origin5224K044NTDCCPPPeriapical abscess without sinus5225K047NTDCCPPChronic apical periodontitis5226K045NTDCCPPPeriapical abscess with sinus5227K046NTDCCPPRadicular cyst5228K048NTDCOther and unspecified diseases of pulp and periapical tissues5229K0490Unspecified diseases of pulp and periapical tissuesNTDCCPPOther and unspecified diseases of pulp and periapical tissues5229K0499Other diseases of pulp and periapical tissuesNTDCCPPAcute gingivitis, plaque induced52300K0500NTDCCPPAcute gingivitis, non-plaque induced52301K0501NTDCCPPChronic gingivitis, plaque induced52310K0510NTDCCPPChronic gingivitis, non-plaque induced52311K0511NTDCCPPGingival recession, unspecified52320K060Gingival recessionNTDCCPPGingival recession, minimal52321K060Gingival recessionNTDCCPPGingival recession, moderate52322K060Gingival recessionNTDCCPPGingival recession, severe52323K060Gingival recessionNTDCCPPGingival recession, localized52324K060Gingival recessionNTDCCPPGingival recession, generalized52325K060Gingival recessionNTDCCPPAggressive periodontitis, unspecified52330K0520NTDCCPPAggressive periodontitis, localized52331K0521NTDCCPPAggressive periodontitis, generalized52332K0522NTDCCPPAcute periodontitis52333K0520NTDCCPPChronic periodontitis, unspecified52340K0530NTDCCPPChronic periodontitis, localized52341K0531NTDCCPPChronic periodontitis, generalized52342K0532NTDCCPPPeriodontosis5235K0540NTDCCPPAccretions on teeth5236K036Deposits (accretions) on teethNTDCCPPOther specified periodontal diseases5238K055Other periodontal diseasesNTDCCPPOther specified periodontal diseases5238K061Gingival enlargementNTDCCPPUnspecified gingival and periodontal disease5239K056Periodontal disease, unspecifiedNTDCCPPMajor anomalies of jaw size, unspecified anomaly52400M2600Unspecified anomaly of jaw sizeNTDCMajor anomalies of jaw size, maxillary hyperplasia52401M2601Maxillary hyperplasiaNTDCMajor anomalies of jaw size, 52402M2603Mandibular hyperplasiaNTDCMajor anomalies of jaw size, maxillary hypoplasia52403M2602Maxillary hypoplasiaNTDCMajor anomalies of jaw size, mandibular hypoplasia52404M2604Mandibular hypoplasiaNTDCMajor anomalies of jaw size, macrogenia52405M2605MacrogeniaNTDCMajor anomalies of jaw size, microgenia52406M2606MicrogeniaNTDCExcessive tuberosity of jaw52407M2607NTDCMajor anomalies of jaw size, other specified anomaly52409M2609Other specified anomalies of jaw sizeNTDCAnomalies of relationship of jaw to cranial base, unspecified anomaly52410M2610Unspecified anomaly of relationship of jaw-cranial base relationship NTDCAnomalies of relationship of jaw to cranial base, maxillary asymmetry52411M2611Maxillary asymmetryNTDCAnomalies of relationship of jaw to cranial base, other jaw asymmetry52412M2612Other jaw asymmetryNTDCAnomalies of relationship of jaw to cranial base, other specified anomaly52419M2619Other specified anomalies of jaw-cranial base relationshipNTDCUnspecified anomaly of dental arch relationship52420M2620NTDCMalocclusion, Angle's class I52421M26211NTDCMalocclusion, Angle's class II52422M26212NTDCMalocclusion, Angle's class III52423M26213NTDCOpen anterior occlusal relationship52424M26220NTDCOpen posterior occlusal relationship52425M26221NTDCExcessive horizontal overlap52426M2623NTDCReverse articulation52427M2624NTDCAnomalies of interarch distance52428M2625NTDCOther anomalies of dental arch relationship52429M2629NTDCUnspecified anomaly of tooth position of fully erupted teeth52430M2630Unspecified anomaly of tooth position of fully erupted tooth or teethNTDCCrowding of teeth52431M2631Crowding of fully erupted teethNTDCExcessive spacing of teeth52432M2632Excessive spacing of fully erupted teethNTDCHorizontal displacement of teeth52433M2633Horizontal displacement of fully erupted tooth or teethNTDCVertical displacement of teeth52434M2634Vertical displacement of fully erupted tooth or teethNTDCRotation of tooth/teeth52435M2635Rotation of fully erupted tooth or teethNTDCInsufficient interocclusal distance of teeth (ridge)52436M2636Insufficient interocclusal distance of fully erupted teeth (ridge)NTDCExcessive interocclusal distance of teeth52437M2637Excessive interocclusal distance of fully erupted teethNTDCOther anomalies of tooth position52439M2639Other anomalies of tooth position of fully erupted tooth or teethNTDCMalocclusion, unspecified5244M264NTDCDentofacial functional abnormality, unspecified52450M2650Dentofacial functional abnormalities, unspecifiedNTDCAbnormal jaw closure52451M2651NTDCLimited mandibular range of motion52452M2652NTDCDeviation in opening and closing of the mandible52453M2653NTDCInsufficient anterior guidance52454M2654NTDCCentric occlusion maximum intercuspation discrepancy52455M2655NTDCNon-working side interference52456M2656NTDCLack of posterior occlusal support52457M2657NTDCOther dentofacial functional abnormalities52459M2659NTDCTemporomandibular joint disorders, unspecified52460M2660Temporomandibular joint disorder, unspecifiedNTDCTemporomandibular joint disorders, unspecified52460M2669Other specified disorders of temporomandibular jointNTDCTemporomandibular joint disorders, adhesions and ankylosis (bony or fibrous)52461M2661Adhesions and ankylosis of temporomandibular jointNTDCTemporomandibular joint disorders, arthralgia of temporomandibular joint52462M2662Arthralgia of temporomandibular jointNTDCTemporomandibular joint disorders, articular disc disorder (reducing or non-reducing)52463M2663Articular disc disorder of temporomandibular jointNTDCTemporomandibular joint sounds on opening and/or closing the jaw52464M2669Other specified disorders of temporomandibular joint NTDCOther specified temporomandibular joint disorders52469M2669Other specified disorders of temporomandibular joint NTDCDental alveolar anomalies, unspecified alveolar anomaly52470M2670Unspecified alveolar anomalyNTDCAlveolar maxillary hyperplasia52471M2671NTDCAlveolar mandibular hyperplasia52472M2672NTDCAlveolar maxillary hypoplasia52473M2673NTDCAlveolar mandibular hypoplasia52474M2674NTDCVertical displacement of alveolus and teeth52475M2679Other specified alveolar anomalyNTDCOcclusal plane deviation52476M2679Other specified alveolar anomalyNTDCOther specified alveolar anomaly52479M2679Other specified alveolar anomalyNTDCAnterior soft tissue impingement52481M2681NTDCPosterior soft tissue impingement52482M2682NTDCOther specified dentofacial anomalies52489M264Malocclusion, unspecifiedNTDCOther specified dentofacial anomalies52489M2689Other dentofacial anomaliesNTDCUnspecified dentofacial anomalies5249M269Dentofacial anomaly, unspecifiedNTDCExfoliation of teeth due to systemic causes5250K080NTDCAcquired absence of teeth, unspecified52510K08109Complete loss of teeth, unspecified cause, unspecified classNTDCLoss of teeth due to periodontal disease52512K08429Partial loss of teeth due to periodontal diseases, unspecified classNTDCCPPLoss of teeth due to caries52513K08439Partial loss of teeth due to caries unspecified classNTDCCPPOther loss of teeth52519K08499Partial loss of teeth due to other unspecified cause, unspecified classNTDCCPPUnspecified atrophy of edentulous alveolar ridge52520K0820NTDCMinimal atrophy of the mandible52521K0821NTDCModerate atrophy of the mandible52522K0822NTDCSevere atrophy of the mandible52523K0823NTDCMinimal atrophy of the maxilla52524K0824NTDCModerate atrophy of the maxilla52525K0825NTDCSevere atrophy of the maxilla52526K0826NTDCRetained dental root5253K083NTDCComplete edentulism, unspecified52540K08109Complete loss of teeth, unspecified cause, unspecified classNTDCComplete edentulism, class I52541K08101Complete loss of teeth, unspecified cause, class INTDCComplete edentulism, class II52542K08102Complete loss of teeth, unspecified cause, class IINTDCComplete edentulism, class III52543K08103Complete loss of teeth, unspecified cause, class IIINTDCComplete edentulism, class IV52544K08104Complete loss of teeth, unspecified cause, class IVNTDCPartial edentulism, unspecified52550K08409Partial loss of teeth, unspecified cause, unspecified classNTDCCPPPartial edentulism, class I52551K08401Partial loss of teeth, unspecified cause, class INTDCCPPPartial edentulism, class II52552K08402Partial loss of teeth, unspecified cause, class IINTDCCPPPartial edentulism, class III52553K08403Partial loss of teeth, unspecified cause, class IIINTDCCPPPartial edentulism, class IV52554K08404Partial loss of teeth, unspecified cause, class IVNTDCCPPUnspecified unsatisfactory restoration of tooth52560K0850Unsatisfactory restoration of tooth, unspecifiedNTDCCPPOpen restoration margins52561K0851Open restoration margins of toothNTDCCPPUnrepairable overhanging of dental restorative materials52562K0852NTDCCPPFractured dental restorative material without loss of material52563K08530NTDCCPPFractured dental restorative material with loss of material52564K08531NTDCCPPContour of existing restoration of tooth biologically incompatible with oral health52565K0854NTDCCPPAllergy to existing dental restorative material52566K0855NTDCCPPPoor aesthetics of existing restoration52567K0856Poor aesthetic of existing restoration of toothNTDCCPPOther unsatisfactory restoration of existing tooth52569K0859Other unsatisfactory restoration of toothNTDCCPPOsseointegration failure of dental implant52571M2761NTDCCPPPost-osseointegration biological failure of dental implant52572M2762NTDCCPPPost-osseointegration mechanical failure of dental implant52573M2763NTDCCPPOther endosseous dental implant failure52579M2769NTDCCPPOther specified disorders of the teeth and supporting structures5258K088Other specified disorders of teeth and supporting structuresNTDCCPPOther specified disorders of the teeth and supporting structuresM2679Other specified alveolar anomaliesNTDCUnspecified disorder of the teeth and supporting structures5259K089Disorder of teeth and supporting structures, unspecifiedNTDCCPPDevelopmental odontogenic cysts5260K090NTDCFissural cysts of jaw5261K091Developmental (nonodotogenic) cysts of oral regionNTDCOther cysts of jaws5262M2749NTDCCentral giant cell (reparative) granuloma5263M271Giant cell granuloma, centralNTDCInflammatory conditions of jaw5264M272NTDCAlveolitis of jaw5265M273NTDCPerforation of root canal space52661M2751Perforation of root canal space due to endodontic treatmentNTDCCPPEndodontic overfill52662M2752NTDCCPPEndodontic underfill52663M2753NTDCCPPOther periradicular pathology associated with previous endodontic treatment52669M2759NTDCCPPExostosis of jaw52681M278Other specified diseases of jawsNTDCOther specified diseases of the jaws52689M278Other specified diseases of jawsNTDCUnspecified disease of the jaws5269M279Disease of the jaws, unspecifiedNTDCAtrophy of salivary gland5270K110NTDCHypertrophy of salivary gland5271K111NTDCSialoadenitis5272K1120Sialoadenitis, unspecifiedNTDCAbscess of salivary gland5273K113NTDCFistula of salivary gland5274K114NTDCSialolithiasis5275K115NTDCMucocele of salivary gland5276K116NTDCDisturbance of salivary secretion5277K117Disturbances of salivary secretionNTDCDisturbance of salivary secretion5277R682Dry mouth, unspecifiedNTDCOther specified diseases of the salivary glands5278K118Other diseases of salivary glandsNTDCUnspecified disease of the salivary glands5279K119Disease of the salivary glands, unspecifiedNTDCStomatitis and mucositis, unspecified52800K122Cellulitis and abscess of mouthNTDCStomatitis and mucositis, unspecified52800K1230Oral mucositis (ulcerative), unspecifiedNTDCMucositis (ulcerative) due to antineoplastic therapy52801K1231Oral mucositis (ulcerative) due to antineoplastic therapyNTDCMucositis (ulcerative) due to antineoplastic therapy52801K1233Oral mucositis (ulcerative) due to radiationNTDCMucositis (ulcerative) due to other drugs52802K1232Oral mucositis (ulcerative) due to other drugsNTDCOther stomatitis and mucositis (ulcerative)52809K121Other forms of stomatitisNTDCOther stomatitis and mucositis (ulcerative)52809K1239Other oral mucositis (ulcerative)NTDCCancrum oris5281A690Necrotizing ulcerative stomatitisNTDCOral aphthae5282K120Recurrent oral aphthaeNTDCCellulitis and abscess of oral soft tissues5283K122Cellulitis and abscess of mouthNTDCCysts of oral soft tissues5284K098Other cysts of oral region, not elsewhere classifiedNTDCDiseases of lips5285K130NTDCLeukoplakia of oral mucosa, including tongue5286K1321NTDCMinimal keratinized residual ridge mucosa52871K1322NTDCExcessive keratinized residual ridge mucosa52872K1323NTDCOther disturbances of oral epithelium, including tongue52879K1329NTDCOral submucosal fibrosis, including of tongue5288K135Oral submucosal fibrosisNTDCOther and unspecified diseases of the oral soft tissues5289K1370Unspecified lesions of oral mucosaNTDCOther and unspecified diseases of the oral soft tissues5289K1379Other lesions of oral mucosaNTDCGlossitis5290K140NTDCGeographic tongue5291K141NTDCMedian rhomboid glossitis5292K142NTDCHypertrophy of tongue papillae5293K143NTDCAtrophy of tongue papillae5294K144NTDCPlicated tongue5295K145NTDCGlossodynia5296K146NTDCOther specified conditions of the tongue5298K148Other diseases of the tongueNTDCUnspecified condition of the tongue5299K149Disease of tongue, unspecifiedNTDCJaw pain78492R6884NTDCCPPNonspecific abnormal findings in saliva7924R859Unspecified abnormal finding in specimens from digestive organs and abdominal cavityNTDCFitting and adjustment of dental prosthetic deviceV523Z463Encounter for fitting and adjustment of dental prosthetic deviceNTDCCPPFitting and adjustment of orthodontic devicesV534Z464Encounter for fitting and adjustment of orthodontic deviceNTDCCPPOrthodontics aftercareV585Z464Encounter for fitting and adjustment of orthodontic deviceNTDCCPPDental examinationV722Z0120Encounter for dental examination and cleaning without abnormal findingsNTDCCPPDental examinationV723Z0121Encounter for dental examination and cleaning with abnormal findingsNTDCCPPAPPENDIX 2OPTIONAL FACTORS/ANALYSES THAT MAY BE INCLUDED IN AN EXPANDED ED-NTDC SURVEILLANCE SYSTEMOptional IndicatorsED visit for CPP based on first listed diagnosisED visit for CPP based on any listed diagnosisED visit for CPP based on first listed reason for visitED visit for CPP based on any listed reason for visitED visit for CPP based on any listed diagnosis and/or any listed reason for visit ED visit for any oral condition based on first listed diagnosisED visit for any oral condition based on any listed diagnosisED visit for any oral condition based on first listed reason for visitED visit for any oral condition based on any listed reason for visitED visit for any oral condition based on any listed diagnosis and/or any listed reason for visitOptional IndicatorSEDD Data Element, ICD-9 SEDD Data Element, ICD-10Comments/NotesCPP 1st diagnosisDX1 I10_DX1Include 1st listed diagnosis onlyCPP any diagnosisDXnI10_DXnInclude all listed diagnosesCPP 1st reason visitDX_Visit_Reason1 I10_Visit_Reason1Include 1st listed reason onlyCPP any reason visitDX_Visit_Reasonn I10_Visit_ReasonnInclude all listed reasonsCPP any diagnosis/visitDXn & DX_Visit_Reasonn I10_DXn & I10_Visit_ReasonnInclude all listed diagnoses & reasonsAny oral 1st diagnosisDX1 I10_DX1Include 1st listed diagnosis onlyAny oral any diagnosisDXnI10_DXnInclude all listed diagnosesAny oral 1st reason visitDX_Visit_Reason1 I10_Visit_Reason1Include 1st listed reason onlyAny oral any reason visitDX_Visit_Reasonn I10_Visit_ReasonnInclude all listed reasonsAny oral any diagnosis/visitDXn & DX_Visit_Reasonn I10_DXn & I10_Visit_ReasonnInclude all listed diagnoses & reasonsOptional Stratification Factors and Analyses Factors/AnalysesSEDD Data Element NameNotes/CommentsSexFEMALEMarital statusMARITALSTATUSUB04Geographic locationZIP or ZIP3Patient zip code can be used to define geographic locationsHomelessnessHomelessNot available for all states.Weekend admissionAWEEKENDIncomeZIPINC_QRTLZIPINC_QRTL provides a quartile classification of the estimated median household income of residents in the patient's ZIP Code. The quartiles are identified by values of 1 to 4, indicating the poorest to wealthiest populations. These values are derived from ZIP Code-demographic data obtained from Claritas. Because these estimates are updated annually, the value ranges for the ZIPINC_QRTL categories vary by year.Revisit by same patientVisitLink & DaysToEventThe VisitLink data element is one of two data elements that are supplemental information created for HCUP States for which there are encrypted person identifiers. The visit linkage variable (VisitLink) can be used in tandem with the timing variable (DaysToEvent) to study multiple hospital visits for the same patient across hospitals and time while adhering to strict privacy regulations. Not available for all states.Trends over timeGenerate indicators for multiple years to determine if ED visits due to NTDC have increased, decreased or remained the same.APPENDIX 3SAMPLE SAS CODEGeneral InformationTo assist states with the process of generating the ED-NTDC indicators, ASTDD is providing sample SAS code. If you are using SPSS or Stata you will need to modify the code accordingly. IMPORTANT: All states should review and revise the sample code to meet their individual needs. States may have multiple SEDD files for a given year, but the data needed for the recommended ED-NTDC indicators are in the core file. Following are instructions on how to load the core file into your statistical package.Go to the HCUP website: down to “File Specifications and Load Programs”. Click on the load program link for the statistical software package you will be using (SAS, SPSS, Stata). This example uses SAS.Select the state and year you want to downloadFor the database option select SEDDClick “Find”A set of load programs for your state and year will appear at the bottom of the page459930564135Select “Core SAS load program” and save to your hard drive After saving the load program, insert the correct file address and name for your state “core.asc” file in the code line at the beginning of the Data StepRun the load program and the core.asc file will be loaded into SASSample SAS CodeNOTE: Before using this code you should change the “set” file name to match the name and location of your data file. All states should review and revise the sample code to meet their individual needs.*Coding for recommended indicator #1, ED visit for NTDC based on first listed diagnosis. This coding is for pre-2015 data sets with ICD-9 diagnostic codes. For 2015 datasets, both ICD-9 and ICD-10 codes should be included.data StateCore; set StateCore;NTDC_dx1=0; *set variable to 0 and then change to 1 if first DX variable has an NTDC code;If DX1 in ('5200', '5201', '5202', '5203', '5204', '5205', '5206', '5207', '5208', '5209', '52100', '52101', '52102', '52103', '52104', '52105', '52106', '52107', '52108', '52109', '52110', '52111', '52112', '52113', '52114', '52115', '52120', '52121', '52122', '52123', '52124', '52125', '52130', '52131', '52132', '52133', '52134', '52135', '52140', '52141', '52142', '52149', '5215', '5216', '5217', '52181', '52189', '5219', '5220', '5221', '5222', '5223', '5224', '5225', '5226', '5227', '5228', '5229', '52300', '52301', '52310', '52311', '52320', '52321', '52322', '52323', '52324', '52325', '52330', '52331', '52332', '52333', '52340', '52341', '52342', '5235', '5236', '5238', '5239', '52400', '52401', '52402', '52403', '52404', '52405', '52406', '52407', '52409', '52410', '52411', '52412', '52419', '52420', '52421', '52422', '52423', '52424', '52425', '52426', '52427', '52428', '52429', '52430', '52431', '52432', '52433', '52434', '52435', '52436', '52437', '52439', '5244', '52450', '52451', '52452', '52453', '52454', '52455', '52456', '52457', '52459', '52460', '52461', '52462', '52463', '52464', '52469', '52470', '52471', '52472', '52473', '52474', '52475', '52476', '52479', '52481', '52482', '52489', '5249', '5250', '52510', '52512', '52513', '52519', '52520', '52521', '52522', '52523', '52524', '52525', '52526', '5253', '52540', '52541', '52542', '52543', '52544', '52550', '52551', '52552', '52553', '52554', '52560', '52561', '52562', '52563', '52564', '52565', '52566', '52567', '52569', '52571', '52572', '52573', '52579', '5258', '5259', '5260', '5261', '5262', '5263', '5264', '5265', '52661', '52662', '52663', '52669', '52681', '52689', '5269', '5270', '5271', '5272', '5273', '5274', '5275', '5276', '5277', '5278', '5279', '52800', '52801', '52802', '52809', '5281', '5282', '5283', '5284', '5285', '5286', '52871', '52872', '52879', '5288', '5289', '5290', '5291', '5292', '5293', '5294', '5295', '5296', '5298', '5299', '78492', '7924', 'V523', 'V534', 'V585', 'V722', 'V723')then NTDC_dx1=1;run;*Coding for recommended indicator #1, ED visit for NTDC based on first listed diagnosis. This coding is for post-2015 data sets with ICD-10 diagnostic codes. For 2015 datasets, both ICD-9 and ICD-10 codes should be included.data StateCore; set StateCore;NTDC_dx1=0; *set variable to 0 and then change to 1 if first I10_DX variable has an NTDC code;If I10_DX1 in ('A690', 'K000', 'K001', 'K002', 'K003', 'K004', 'K005', 'K006', 'K007', 'K008', 'K009', 'K010', 'K011', 'K023', 'K0251', 'K0261', 'K0262', 'K0263', 'K027', 'K029', 'K030', 'K031', 'K032', 'K033', 'K034', 'K035', 'K036', 'K037', 'K0381', 'K0389', 'K039', 'K040', 'K041', 'K042', 'K043', 'K044', 'K045', 'K046', 'K047', 'K048', 'K0490', 'K0499', 'K0500', 'K0501', 'K0510', 'K0511', 'K0520', 'K0521', 'K0522', 'K0530', 'K0531', 'K0532', 'K0540', 'K055', 'K056', 'K060', 'K061', 'K080', 'K08101', 'K08102', 'K08103', 'K08104', 'K08109', 'K0820', 'K0821', 'K0822', 'K0823', 'K0824', 'K0825', 'K0826', 'K083', 'K08401', 'K08402', 'K08403', 'K08404', 'K08409', 'K08429', 'K08439', 'K08499', 'K0850', 'K0851', 'K0852', 'K08530', 'K08531', 'K0854', 'K0855', 'K0856', 'K0859', 'K088', 'K089', 'K090', 'K091', 'K098', 'K110', 'K111', 'K1120', 'K113', 'K114', 'K115', 'K116', 'K117', 'K118', 'K119', 'K120', 'K121', 'K122', 'K1230', 'K1231', 'K1232', 'K1233', 'K1239', 'K130', 'K1321', 'K1322', 'K1323', 'K1329', 'K135','K1370', 'K1379', 'K140', 'K141', 'K142', 'K143', 'K144', 'K145', 'K146', 'K148', 'K149', 'M2600', 'M2601', 'M2602', 'M2603', 'M2604', 'M2605', 'M2606', 'M2607', 'M2609', 'M2610', 'M2611', 'M2612', 'M2619', 'M2620', 'M26211', 'M26212', 'M26213', 'M26220', 'M26221', 'M2623', 'M2624', 'M2625', 'M2629', 'M2630', 'M2631', 'M2632', 'M2633', 'M2634', 'M2635', 'M2636', 'M2637', 'M2639', 'M264', 'M2650', 'M2651', 'M2652', 'M2653', 'M2654', 'M2655', 'M2656', 'M2657', 'M2659', 'M2660', 'M2661', 'M2662', 'M2663', 'M2669', 'M2670', 'M2671', 'M2672', 'M2673', 'M2674', 'M2679', 'M2681', 'M2682', 'M2689', 'M269', 'M271', 'M272', 'M273', 'M2749', 'M2751', 'M2752', 'M2753', 'M2759', 'M2761', 'M2762', 'M2763', 'M2769', 'M278', 'M279', 'R682', 'R6884', 'R859', 'Z0120', 'Z0121', 'Z463', 'Z464')then NTDC_dx1=1;run;*Coding for recommended indicator #2, ED visit for NTDC based on any listed diagnosis. This coding is for pre-2015 data sets with ICD-9 diagnostic codes. For 2015 datasets, both ICD-9 and ICD-10 codes should be included. NOTE: SEDD has variables for up to 25 diagnoses.data StateCore; set StateCore;array DX{25} DX1--DX25;NTDC_dx_any=0; *set variable to 0 and then change to 1 if any DX variables have an NTDC code;Do i=1 to 25;if DX{i} in (insert ICD-9 codes listed for recommended indicator #1) then NTDC_dx_any=1;end;run;*Coding for recommended indicator #2, ED visit for NTDC based on any listed diagnosis. This coding is for post-2015 data sets with ICD-10 diagnostic codes. For 2015 datasets, both ICD-9 and ICD-10 codes should be included. NOTE: SEDD has variables for up to 25 diagnoses.data StateCore; set StateCore;array DX{25} I10_DX1—I10_DX25;NTDC_dx_any=0; *set variable to 0 and then change to 1 if any I10_DX variables have an NTDC code;Do i=1 to 25;if DX{i} in (insert ICD-10 codes listed for recommended indicator #1)then NTDC_dx_any=1;end; run;*Coding for recommended indicator #3, ED visit for NTDC based on first listed reason for visit. This coding is for pre-2015 data sets with ICD-9 diagnostic codes. For 2015 datasets, both ICD-9 and ICD-10 codes should be included. data StateCore; set StateCore;NTDC_RsnVis1=0;If DX_Visit_Reason1 in (insert ICD-9 codes listed for recommended indicator #1)then NTDC_RsnVis1=1;run;*Coding for recommended indicator #3, ED visit for NTDC based on first listed reason for visit. This coding is for post-2015 data sets with ICD-10 diagnostic codes. For 2015 datasets, both ICD-9 and ICD-10 codes should be included. data StateCore; set StateCore;NTDC_RsnVis1=0;If I10_Visit_Reason1 in (insert ICD-10 codes listed for recommended indicator #1)then NTDC_RsnVis1=1;run;*Coding for recommended indicator #4, ED visit for NTDC based on any listed reason for visit. This coding is for pre-2015 data sets with ICD-9 diagnostic codes. For 2015 datasets, both ICD-9 and ICD-10 codes should be included. NOTE: SEDD has variables for up to 3 reasons for visit.data StateCore; set StateCore;array rsn{3} DX_Visit_Reason1--DX_Visit_Reason3;NTDC_RsnVis_any=0; *set variable to 0 and then change to 1 if any DX_Visit_ReasonN variables have an NTDC code;Do i=1 to 3;if rsn{i} in ( insert ICD-9 codes listed for recommended indicator #1)then NTDC_RsnVis_any=1;end;run;*Coding for recommended indicator #4, ED visit for NTDC based on any listed reason for visit. This coding is for post-2015 data sets with ICD-10 diagnostic codes. For 2015 datasets, both ICD-9 and ICD-10 codes should be included. NOTE: SEDD has variables for up to 3 reasons for visit.data StateCore; set StateCore;array rsn{3} I10_Visit_Reason1—I10_Visit_Reason3;NTDC_RsnVis_any=0; *set variable to 0 and then change to 1 if any I10_Visit_ReasonN variables have an NTDC code;Do i=1 to 3;if rsn{i} in ( insert ICD-10 codes listed for recommended indicator #1)then NTDC_RsnVis_any=1;end;run;*Coding for recommended indicator #5, ED visit for NTDC based on any listed diagnosis and/or any listed reason for visit. data StateCore; set StateCore;NTDC_DXorRsn=0;if NTDC_dx_any=1 or NTDC_RsnVis_any=1 then NTDC_DXorRsn=1;run;*To generate counts for the five indicators. proc freq data = StateCore;tables NTDC_dx1 NTDC_dx_any NTDC_RsnVis1 NTDC_RsnVis_any NTDC_DXorRsn;run;*To generate rate per 100,000 population. NOTE: This is not SAS code. (indicator count/population estimate) * 100,000Example: First diagnosis NTDC count is 36,188, state population estimate is 4,400,477Rate of ED NTDC visits per 100,000 population = (36,188 / 4,400,477) * 100,000 = 822.4 per 100,000 population*To generate rate per 10,000 ED visits. NOTE: This is not SAS code. (indicator count / total ED visit count) * 10,000Example: First diagnosis NTDC count is 36,188, total ED visit count is 2,036,780rate of ED NTDC per 10,000 ED visits = (36,188 / 2,036,780) * 10,000 = 177.7 per 10,000 ED visits*To generate total charges, use the following SAS code. The first diagnosis indicator is used in this example.proc means data=StateCore mean median min max stddev sum;var totchg;where NTDC_dx1=1;run; *For recommended stratified analyses by age group, race/ethnicity, and primary payer, use variables AGE, PAY1, and RACE.data StateCore; set StateCore;if age lt 20 then agecat=1;if age ge 20 and age lt 45 then agecat=2; if age ge 45 and age lt 65 then agecat=3; if age ge 65 then agecat=4;run;PROC FORMAT; *to format primary payer, race, and new age category variables;value agec 1='<20 years' 2='20-44 years' 3='45-64 years' 4='65 or more years';value pay 1='Medicare' 2='Medicaid' 3='Private' 4='Self Pay' 5='No charge' 6='Other';value rac 1='white' 2='black' 3='Hispanic' 4='Asian/PacIsl' 5='NatAmer' 6='Other';value yn 0='No' 1='Yes';run;*Example - stratified analysis for NTDC first diagnosis indicator.proc freq data=StateCore;tables agecat pay1 race;where NTDC_dx1=1;format agecat agec. pay1 pay. race rac.;run;*Example - to compare NTDC=yes vs. NTDC=no stratified analysis for NTDC first diagnosis.proc freq data=StateCore;tables NTDC_dx1*(agecat pay1 race);format agecat agec. pay1 pay. race rac. NTDC_dx1 yn.;run;APPENDIX 4ACRONYMS USED IN THIS DOCUMENT ASTDDAssociation of State and Territorial Dental DirectorsCPPConditions associated with caries, periodontal disease or associated preventive proceduresEDEmergency departmentHCUPHealthcare cost and utilization project () ICD-9International Classification of Diseases, Ninth RevisionICD-10International Classification of Diseases, Tenth Revision?NTDCNon-traumatic dental conditionSEDDState emergency department databases ()SIDState inpatient databases () SOHPState oral health program ................
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